The role of perforators in chronic venous insufficiency

2010 ◽  
Vol 25 (1) ◽  
pp. 3-10 ◽  
Author(s):  
T F O'Donnell
Keyword(s):  
Best Practice ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Wound Dressings ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Consensus Document ◽  
Grade Method ◽  
Compression Bandages ◽  
Effective Manner

Thesis Venous ulcers (VU) consume considerable resources in healthcare systems, up to 1% of healthcare budgets in industrialized countries. Best practice guidelines (GLs) incorporate evidence-based diagnostic and therapeutic recommendations in a cost-effective manner and have been associated with improved and less costly outcomes for many diseases. Objectives To determine whether there are common elements in GLs for VU and their evidentiary strength. Methods A systematic analysis of GLs for VU that were identified through clinicaltrials.gov, a government-sponsored website, and from experts outside the USA. Results Ten of 12 GLs on VU (7 North America and 5 Europe) were evidence-based, with the majority using the GRADE method. Only two had been developed or updated within the last three years. Venous duplex and ankle ABIs were recommended in all. Debridement was suggested in two, while simple non-adherent wound dressings were favoured in nine, and hydrocolloid in two. Only one GL discussed a range of dressing options, dependent on the condition of the VU. High pressure multi-layer compression bandages were favoured in 10. Only two focused on the importance of improving ankle joint mobility. Conclusions While there are numerous evidence-based GLs for VU, the majority may lag recent developments in the field. There is consensus on the elements for dressings and compression among the various GLs, which should facilitate the development of a common consensus GL, similar to that for DVT/PE. To improve patient care and reduce wasted resources, it is imperative for specialty societies to develop this consensus document.

Technology-Assisted Delivery of Parenting Programs

2017 ◽  
pp. 294-304
Author(s):  
Karen M. T. Turner ◽  
Sabine Baker ◽  
Jamin J. Day
Keyword(s):  
Cost Effective ◽  
Parenting Programs ◽  
The Internet ◽  
Triple P ◽  
Evidence Based ◽  
Web Based ◽  
Parenting Support ◽  
Effective Manner ◽  
Assisted Delivery ◽  
Program Engagement

Increasingly, parents are looking to the Internet for information and advice about parenting. This presents an opportunity to broaden the reach and availability of evidence-based parenting support in an extremely cost-effective manner if we can harness the power of the Internet to deliver engaging and effective interactive programs. Online platforms provide the potential to tailor content and feedback to the user and reduce barriers to participation through ease and immediacy of access, flexibility and self-paced delivery, and increased privacy. This chapter examines the role of technology-assisted delivery of parenting support and discusses challenges in providing evidence-based parenting programs online. Learnings from research into the Triple P Online family of web-based programs are shared, including implementation issues that influence program outcomes, such as program engagement, dosage, and provision of professional support.

Determining Evidence-Based Outcomes in School-Aged Youth: Free-Access Instruments for School Counselor Use

2019 ◽  
Vol 22 (1b) ◽  
pp. 2156759X1983443 ◽  
Author(s):  
Gerta Bardhoshi ◽  
Nicole Cobb ◽  
Bradley T. Erford
Keyword(s):  
School Counselors ◽  
Disruptive Behavior ◽  
School Counselor ◽  
Cost Effective ◽  
Counseling Services ◽  
Free Access ◽  
Assessment Instruments ◽  
Evidence Based ◽  
Group Interventions ◽  
Effective Manner

School counselors must demonstrate effectiveness of counseling services in a cost-effective manner. This article reviews and applies commonly used, free-access assessment instruments for use with school-aged youth to provide evidence of effective individual, small-group, and large-group interventions. We present instruments assessing depression, anxiety, disruptive behavior, and trauma, so that school counselors can learn basic administration, scoring, interpretation procedures, and psychometric utility to allow immediate use with diverse students.

Incorporating Pavement Smoothness Benefits to Enhance the Iowa Department of Transportation’s Pavement Type Determination Process

2020 ◽  
Vol 2674 (5) ◽  
pp. 563-571
Author(s):  
Max Grogg ◽  
Kelly Smith ◽  
Chris Williges ◽  
Scott Schram
Keyword(s):  
Best Practice ◽  
Net Present Value ◽  
Cost Benefit ◽  
Cost Effective ◽  
Pavement Management ◽  
State Highway ◽  
Type Selection ◽  
Effective Manner ◽  
Federal Highway ◽  
Accepted Practice

The Federal Highway Administration (FHWA)’s Pavement Policy as codified in 23 CFR 626 states, “Pavement shall be designed to accommodate current and predicted traffic needs in a safe, durable, and cost effective manner” to be eligible for federal highway funding. To meet this requirement, state highway agencies have developed pavement type determination (PTD) policies, also known as pavement type selection, and implemented pavement management. Iowa Department of Transportation (DOT)’s PTD has been in place for many years; but in 2018, Iowa DOT looked at enhancing their PTD process to address gaps between past practice and best practice. Among the enhancements, user benefit as defined by pavement smoothness was utilized when net present value (NPV) alone could not definitively distinguish a preferred alternative. The smoothness benefit would become the divisor in a cost–benefit (C/B) ratio that would be used to determine the preferred alternate for the PTD. The cost portion of the ratio would remain the NPV of agency costs for the construction and projected rehabilitations during the analysis period. After a literature review and interviews of comparable state DOTs, several modifications to Iowa DOT’s PTD and the C/B ratio were analyzed and adopted. The modifications range from accepted practice changes, such as the use of a longer analysis period (50 years), to unconventional techniques, such as the consideration of smoothness. Iowa DOT believes these changes provide a more robust PTD. They are also considering additional improvements based upon additional research and policy making.

Enterprise Crowdsourcing Platform to Improve HR Workflow

2020 ◽  
Vol 9 (5) ◽  
pp. 5-8 ◽  
Author(s):  
G. Zuev
Keyword(s):  
Large Scale ◽  
Best Practice ◽  
Cost Effective ◽  
Hr Management ◽  
Practical Project ◽  
Effective Manner ◽  
Wide Range ◽  
Hr Managers ◽  
Short Time ◽  
Small Parts

Crowdsourcing technologies may solve a wide range of business issues: improve efficiency of HR management, increase customer loyalty and maximize economic efficiency of whole enterprise. The recent years best practice has shown how crowdsourcing is gaining particular relevance of human resource management, allowing HR managers to resolve organization relevant problems in quick and cost-effective manner. Important advantage of crowdsourcing сomes from his main ability: decomposition of tasks into small parts and the ability to perform it’s remotely, via Internet. Thanks to this, not only large corporations, but also small and medium-sized businesses can execute a large-scale projects in a short time. This article discusses the main approaches and principles of practical project management via crowdsourcing platforms, using as the example “Beorg Smart Vision” solution.

The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice: Part One

2013 ◽  
Vol 15 (1) ◽  
pp. 18-34 ◽  
Author(s):  
Tomi Gomory
Keyword(s):  
Mental Health ◽  
Clinical Judgment ◽  
Evidence Based Medicine ◽  
Process Model ◽  
Best Practice ◽  
Political Process ◽  
Community Treatment ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Based Medicine

The present article outlines the major limitations of evidence-based medicine (EBM) and through a close review demonstrates that the three component EBM process model is a pseudoscientific tool. Its “objective” component is the collection, systematic analysis, and listing of “effective” treatments applying a research hierarchy from most rigorous (systematic reviews of randomized controlled trials [RCTs]) to least rigorous (expert opinion). Its two subjective components are the clinical judgment of helping professionals about which “evidence-based” treatment to select and the specific and unique relevant personal preferences of the potential recipients regarding treatment. This procedural mishmash provides no more rigor in choosing “best practice” than has been provided by good clinical practitioners in the past because both turn out to be subjective and authority based. The article also discusses EBM’s further methodological dilution in the National Institute of Mental Health (NIMH) endorsed Evidence-Based Mental Health Practice (EBP) movement. In EBP, the allegedly rigorous EBM protocol is altered. Instead of systematic expert protocol-driven EBM reviews of RCTs, NIMH sanctioned expert consensus panels decide “evidence-based practices.” This further problematizes the development of best practices in mental health by converting it to a political process. The article concludes with some observations on these issues. In a second article (part two) forthcoming, assertive community treatment (ACT) is examined as an example of an EBP that fails as a scientifically effective treatment despite its EBP certification and general popularity among practitioners.

Results of a pilot study to examine the effective integration of apprentices into the industrial construction sector

2003 ◽  
Vol 30 (2) ◽  
pp. 391-405 ◽  
Author(s):  
Aminah Robinson Fayek ◽  
Ahmed Shaheen ◽  
Ayo Oduba
Keyword(s):  
Pilot Study ◽  
Best Practice ◽  
Labour Force ◽  
Cost Effective ◽  
Lessons Learned ◽  
Construction Sector ◽  
Skilled Workers ◽  
Industrial Construction ◽  
Effective Manner ◽  
The Impact

The industrial construction sector in Alberta has recently undergone a period of rapid growth, resulting in a shortage of skilled workers in almost all of the major industrial sector trades. To meet these shortages, a need has arisen to increase the utilization of apprentices on industrial construction projects. In an effort to address this issue, the Construction Owners Association of Alberta has established a goal of developing an industry Best Practice on how to improve the on-the-job portion of apprenticeship training and identify means by which the industry can more effectively use apprentices. The challenge is to increase their usage in a cost-effective manner that also provides apprentices with adequate training opportunities. Before this can be done, the impacts and benefits to the various parties involved in industrial construction must be quantified and assessed. This paper describes the findings of a pilot study that was conducted on a major industrial project to help in quantifying the impact of the use of apprentices in the industrial construction sector and to identify methods of effectively increasing their use while simultaneously enhancing their on-the-job learning experience. The main conclusion of this paper is that apprentices can be effectively incorporated in industrial construction, and they can be both productive and cost-effective, provided they are given adequate instruction and supervision. The lessons learned from the study are discussed to provide insight into conducting future studies. Recommendations for an industry Best Practice on the effective utilization of apprentices are presented.Key words: apprentice, electrician, industrial construction, journeyman, labour force, pipefitter, productivity, training, work sampling.

Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

2014 ◽  
Vol 34 (2) ◽  
pp. 58-68 ◽  
Author(s):  
Mary H. Peterson ◽  
Susan Barnason ◽  
Bill Donnelly ◽  
Kathleen Hill ◽  
Helen Miley ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nursing Care ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Levels Of Evidence ◽  
Evidence Based Nursing

Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice.

scholarly journals Bringing Top-End Endoscopy to Regional Australia: Hurdles and Benefits

2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
J. Van Den Bogaerde ◽  
D. Sorrentino
Keyword(s):  
Patient Care ◽  
Best Practice ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Recent Experience ◽  
Large Hospital ◽  
New Techniques ◽  
Endoscopy Unit ◽  
Close Cooperation ◽  
Regional Australia

This paper focuses on recent experience in setting up an endoscopy unit in a large regional hospital. The mix of endoscopy in three smaller hospitals, draining into the large hospital endoscopy unit, has enabled the authors to comment on practical and achievable steps towards creating best practice endoscopy in the regional setting. The challenges of using what is available from an infrastructural equipment and personnel setting are discussed. In a fast moving field such as endoscopy, new techniques have an important role to play, and some are indeed cost effective and have been shown to improve patient care. Some of the new techniques and technologies are easily applicable to smaller endoscopy units and can be easily integrated into the practice of working endoscopists. Cost effectiveness and patient care should always be the final arbiter of what is essential, as opposed to what is nice to have. Close cooperation between referral and peripheral centers should also guide these decisions.

Data centre sustainability – Beyond energy efficiency

2018 ◽  
Vol 39 (2) ◽  
pp. 173-182 ◽  
Author(s):  
Sophia Flucker ◽  
Robert Tozer ◽  
Beth Whitehead
Keyword(s):  
Energy Efficiency ◽  
Environmental Impact ◽  
Best Practice ◽  
Cost Effective ◽  
Lifecycle Assessment ◽  
Data Centre ◽  
Effective Manner ◽  
Assessment Approach ◽  
Corporate Social ◽  
Data Centres

Data centres are large energy consumers, which have become more energy efficient in recent years due to increased awareness of opportunities, increasing energy costs and corporate social responsibility pressures. A lifecycle assessment approach identifies two other significant areas of impact: the embodied impact of IT equipment and mechanical and electrical plant, and the electricity source used in operational and embodied processes. Many data centre operators publicise their energy efficiency, some also report on their carbon footprint. However, there is a need for simple tools in order to help operators better understand and quantify the embodied impact and inform green procurement. Focussing purely on energy efficiency may cause a burden shift, e.g. by replacing equipment with more efficient equipment but increasing the embodied impact. The total environmental impact could remain the same/increase, but with the perception of a ‘greener’ data centre. Although currently there is limited data available for data centre life cycle assessments and the process is resource intensive, research has identified which factors significantly impact a facility’s environmental impact. This knowledge should be used in the design process and throughout the data centre lifecycle to minimise data centre environmental impact. Practical application: As the data centre industry continues to grow and its sustainability receives closer scrutiny, it is important to increase awareness of where its highest environment impacts lie and analyse the factors which influence this. This can help inform policy and decision-making to support the design and operation of data centres which are truly more sustainable. It is important that this research is not just theoretical but can translate into practical actions which can be implemented in a cost-effective manner for the benefit of everyone. The current focus in industry has been energy consumption and energy efficiency; many practices which were considered innovative a few years ago have now become standard best practice. It is time to examine which other areas should be prioritised for improvement.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

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